Pandemic: Coronavirus Edition

Did Italy have an outbreak of COVID-19 three months BEFORE China?

November 16, 2020 Dr Stephen Kissler and Matt Boettger Season 1 Episode 51
Pandemic: Coronavirus Edition
Did Italy have an outbreak of COVID-19 three months BEFORE China?
Chapters
Pandemic: Coronavirus Edition
Did Italy have an outbreak of COVID-19 three months BEFORE China?
Nov 16, 2020 Season 1 Episode 51
Dr Stephen Kissler and Matt Boettger

Can you Rate and Give us a Review in Apple Podcasts?

Thank you to all of you who helped us reach our goal to pay off our equipment for this podcast! If you would like to still financially support us for the monthly upkeep and to help hand off some of the editing responsibilities, you can give a one-time donation or become a Patreon member for as little as $5 a month. See the links below. Thank you!

  • Give a one-time gift through Venmo at @mattboettger
  • Give a one-time gift through PayPal here.
  • Give monthly (as little as $5 a month) on our Patreon Page.

Things Discussed on Episode:

Support the show (https://www.patreon.com/pandemicpodcast)

Show Notes Transcript

Can you Rate and Give us a Review in Apple Podcasts?

Thank you to all of you who helped us reach our goal to pay off our equipment for this podcast! If you would like to still financially support us for the monthly upkeep and to help hand off some of the editing responsibilities, you can give a one-time donation or become a Patreon member for as little as $5 a month. See the links below. Thank you!

  • Give a one-time gift through Venmo at @mattboettger
  • Give a one-time gift through PayPal here.
  • Give monthly (as little as $5 a month) on our Patreon Page.

Things Discussed on Episode:

Support the show (https://www.patreon.com/pandemicpodcast)

Matt Boettger:

You're listening to the pandemic podcast. We equip you to live the most real life possible in the face of these crises. My name is Matt Boettger. I'm joined with Dr. Stephen Kissler epidemiologist, the Harvard School of Public Health. Welcome back. How's it going buddy?

Stephen Kissler:

Doing all right. How are you doing Matt?

Matt Boettger:

Good. Hey, this is me being totally oblivious. Did you have here last week?

Stephen Kissler:

I did not

Matt Boettger:

realize

Stephen Kissler:

a week's worth of forgetting to shave here.

Matt Boettger:

That's awesome. man, we just, we need to do a collection for supporting our epidemiologists around the world. Well, it looks fabulous. Thank you.

Stephen Kissler:

I'm glad that most people can't see this.

Matt Boettger:

No, only, only the handful of people on the Facebook group. How's your week then. it's

Stephen Kissler:

been all right. definitely busy, exciting with some more of the new vaccine news coming out. We're just kind of chugging along with our research over here.

Matt Boettger:

Yeah, I am super excited to talk about that a little bit. I proposed this question to you before we went by. I'll throw it again to you, just for the listeners can hear, I was asking you about how, you know, here we have these ups and ups and downs with COVID cases, as curious in light of your studies, how does your studies like research impact or impacted by the change and fluctuations of COVID in around the world? I mean, are you. Is it like you're directly impacted or you just kind of arise above the top and do your own research?

Stephen Kissler:

Yeah, it's the research itself really isn't at least since the spring hasn't really been affected that much by the changing case counts themselves. We just kind of keep doing our work and, you know, a lot of the questions we're trying to answer are, Independent of how many cases are actually circulating. but what does change is, is the conversations surrounding it, for sure. since the spring have been talking with journalists pretty regularly and also just friends and family and things and, yeah, I can definitely see a change in the amount of interest and the types of questions that are being asked over time. so in that sense, it does get busier, but not necessarily from the research side. Yeah. Yeah.

Matt Boettger:

Oh, good. Well, at least Lisa, I feel like you don't, I'm glad, I'm thankful that you don't feel like you're constantly changing every week to being on the media. So that's great that you're a little bit of your own, your own research. A few other things to chat about briefly. Oh, I just want to drop this Mark. I think sent this to us. He can't be with us today, but back in April. I was joking about how we need to do a video. Look with my college. Students have like how we saved the world and they just lay on the couch and just eating potato chips and just like totally haven't showered in a week. And he asked them what they're doing. Like, Hey, I'm saving the world. Right. Sounds so courageous. And it's apparently Mark has shows there's a Jew, there's a German video. So with the translate in English or the exact same thing about. That like the future of this guy, who's like 70 talking about 2020 and the sacrifices. And then all I did was just surf the TV and eat potato chips. And that's how you save the world. So I thought was hilarious. We'll put in the show notes, I was going to do the clip, but then I realized it's all German. So in the subtitles, the usual Lester native labor later is, is German. So, yeah, I'll be the shot. It's it's hilarious. You got to watch it. Check it out, reviews. We love them. Keep them coming. Or you can do that on Apple podcast in the show notes, show notes, show notes helps us rise from the top. That's the second time I've said that too. Is that like a Canadian accent or I'm not sure. we'd love to get them. So, leave us, leave, whatever you think you can leave in a comment even better. You want to support us as little as $5 a month helps us go a long way is at patrion.com/pandemic podcast or a one-time payment, Venmo, PayPal, all in the show notes. And that is about yet. We have a lot to cover, believe it or not, even though it's only been seven days, let's start with, just. The increased cases. I'd love to get your feedback of where we're at right now. Again, I think it was over 180,000 cases in a day. I was at Saturday. it seems like all the comments on the media are saying, this seems like it's just going to continue. There's no, there's no end in sight right now, unless there is something extreme, extreme, done, and I'm not advocating for some kind of universal lockdown, that kind of stuff. I'm just saying, that's the response. So I'd love to get here where you're like state of the union of where we're at right now. When it comes to COVID cases, the, the, the growth and what you think our future holds for us. And then finally, like, what would you, what are some things we should be doing right now? Yeah.

Stephen Kissler:

so it's, it's alarming for sure. You know, last week we were talking about exponential growth and that was just after we surpassed the a hundred thousand case count Mark. Right. And we're well, on track, you know, we were talking about, you know, maybe we'll hit 200,000 by Thanksgiving. I mean, now there's a good chance. We'll hit 200,000 by Tuesday, you know? It's.

Matt Boettger:

Yeah, it is. Yeah. I was so surprised. Oh, I was just, when I saw the news yesterday, like 184,000, I'm like, man, this is going way faster than expected.

Stephen Kissler:

Yeah. Right. And that's, that's exponential growth, right? Like that's, that's it. And it, and it, and again, it matches up with a lot of what we were seeing earlier this spring, where the doubling time for cases is on the order of 10 to 14 days. this is actually even going a little bit. Yeah. Faster than that, which suggests a little bit of, there is also some increase in testing tiny bit. but it's, it's driven by an increase in cases and it's just a epidemic doing what epidemics do. and so there's, there's a lot of spread and it's, it's, it's not a great trajectory to be on, especially going into the holidays coming up, which I know we'll talk a little bit about too. Thanksgiving plans and those kinds of things, but, you know, that said. All of the things that we know to do remain true. it's about physical distancing. It's about wearing masks. It's about washing our hands and just being mindful of the spaces that we're in, reducing gathering sizes, all of these same sorts of things are absolutely effective. I think that the, the important thing though, is that, For many of us living in places like Boston, where it's getting a lot colder very quickly. these, all of these things, especially the gathering things are becoming more difficult behavior early. And there may also be, climate weather related sort of boost that the virus gets this time of year as well. So while all of the same things that worked earlier, still work now. We actually have to be extra vigilant and extra sort of, put in a little bit more effort now because, because this virus is harder to control in the winter than in the summer. yeah. And so that's, that's just the situation we're in. and so, like you said, I think that there's, I, I do hope that we'll be able to avoid, you know, national widespread lockdowns, these kinds of things. But I do think that some of the pragmatic measures that different governments are taking to. Again, limit gathering sizes or at least to put out advisories for these kinds of things are really important right now. cause we have, we have way too much infection in the community to maintain control of it right now. and it's really important to start turning that around, especially as we go into a time of year with the holidays where there are going to be ample opportunities for, just flare ups to continue.

Matt Boettger:

Yeah. Yeah. Well the, yeah, so this is a few things and I had some, my notes kind of like disjointed, but I think they're now really, really well connected. There's a couple things. Number one, we're talking about this increase of surge of infections. I saw two articles. We were joking about this at one said basically, Oh, it's unknown where people are getting infected. And then the very next article said a different one, obviously different publications with Washington post versus the wall street journal, social gatherings are fueling the Krone coronavirus search. So first of all, do we know where this is coming from? Cause it's, these are two suggesting articles, different opinions. And w w you were mentioned, there was a piece that you've read that kind of showed where these, where these viruses or. Where the transmission is principally kind of focused at.

Stephen Kissler:

Yeah. So, this is, this is a recent article, which I will pull up right here. so this is published in nature, which is sort of one of the big, bad journals. So it's like a very, very high profile. A lot of people read it. and by big, bad, I mean, big, big, good. Like they, they publish a lot of guts. Stuff

Matt Boettger:

like that in the, in the, in the eighties, like

Stephen Kissler:

that's what happened. That's

Matt Boettger:

right. I mean, it was good. Yeah. Yeah.

Stephen Kissler:

And so this article is titled mobility network models of COVID-19 explain inequities and informed reopening. and, this is by Serina, Chang and colleagues. I think that it's open access at this point. So, you can. Take a look at it yourself. And they were using these mobility data and linking it up. I need to read this in detail, but Lincoln get up with case counts and basically doing their own sophisticated contact tracing initiative with thousands and thousands of cases. and ultimately what they came up with is this stratified, estimate of the, essentially the additional. Infections that different venues in society are contributing. So they weren't looking at, like personal social gatherings. They were more looking at like sectors of society where infection is happening. and there's, there's sort of a whole gradient of different areas that seem to be contributing to a lot of, infection. But what they found is that, Really far and away, the greatest number of infections that they were able to trace were able to be traced back to, Full service restaurants, basically in person dining, indoor dining. and so that was like a very, a very substantial, seemingly driver bread. And then beyond that, some of the other high hitters were fitness centers, cafes, and snack bars, hotels, and motels, limited service restaurants, these kinds of things. and then it was. After that, you know, sort of the next tier down, which wasn't contributing as much, but still had some transmission where like grocery stores and department stores and gas stations, And that sort of thing. So it sort of gives you this, this rough sense of like different tiers of, of, of where spread is happening. And so according to this article, it really is a lot of spread happening in, restaurants and service settings. So, those are areas where we'll have to really focus a lot on limiting spread as we're going into the fall, because we know that those, those are sort of the, you know, we can look at it from one perspective and say like, Oh, you know, these things are contributing a lot to spread. We have to, you know, like these things are bad, but. Calling things bad. doesn't really help much, usually from a public health perspective. And I think we can see them as opportunities too, right? Like if we want to maximize the value of our efforts, we need to know where to focus them. And so we're going to, probably gain a lot more by figuring out how to make. Indoor dining safe. If it can be safe, then focusing, on some of these other places, like if we had a choice to focus on making grocery stores safer or restaurants safer, and we can only pick one, should probably pick the restaurants because you're going to get two orders of magnitude higher reduction in spread, if you do that. So, so that's the real value of this kind of work. I think

Matt Boettger:

that's great. I am curious in that article, did it put in as part of the research, like, like. working at your own business, going to work that kind of stuff. Was that even on the radar or is that set such a low cause I'm here? The reason why I bring this up is because, our governor here at, in Colorado, wasn't a mandate, but just suggested maybe suggesting that please start working from home if you can. Right. so I didn't know if there's a relationship, is that a place of high transmission or did that not even get into the equation? This study?

Stephen Kissler:

It's I mean, of course it depends so much on where you work.

Matt Boettger:

and so

Stephen Kissler:

the issue, I think that the concern there are, I mean, yes, it does make sense that if you can work from home to work her home, I think because she's limiting any opportunities for spread is a good thing. But I think the issue there is that. A lot of the jobs that you can do from home were already pretty low risk for transmission. Like yeah. When I was just there sitting in my office, if I was wearing a mask typing away at my computer, I can go a day without talking to anybody without even like being face-to-face with them. Like I probably wasn't going to spread COVID even if I was in the office, but I can work from home very easily. But of course that's not the case for, waiter or waitress chef, you know, like you can't really do those things from home. So I think that's part of the issue is that. Asking people to work from home when they can is great, but also isn't really striking right at the heart of the issue. Yeah, sure.

Matt Boettger:

And I, I totally asked that question out of just simply by bias because I think my particular profession, my full-time one is just an unusual one or, it's it's in substance force. A long-term effects really requires like face to face encounter, but technically speaking, we could do it from home. But it's, but it's greatest leverage is really, so then we're in this like unique situation, not that unique, but like, okay. Should we, what's a sacrifice. So, but, it was purely out of selfish. I wanted to throw your, your way. Okay. So I wanna put this in context because we've been talking about increase of a hundred, over 180,000 infections. I've from what I've looked at yesterday, that the death, the mortality rate is still inching its way. It's not necessarily falling anything like the positive. Cases. And so there could be a, this is like this demotion of, it's not that big of a deal. And I, I shared this with you, Steve, and it helped put things in a greater context. I saw this article last week, I think it was said 80% of those who died of COVID-19 in Texas County jails were never convicted of a crime. So the reason why I bring this up is for like 30 seconds, just to, again, to expose the complexity of the transmission and doing our part to be able to. Help reduce the amount and level by which it's transmitted to other people beyond our social settings that I have a friend, it was probably three months ago. I saw her on Facebook plein on, on YouTube going live, trying to get signatures because her father is in prison in Texas and has a very, very high susceptibility rate of COVID could have pretty strong negative consequences. And whoever it was the, of the prison would not allow anyone to go away temporarily to be able to find refuge until this subsides. And so she was pleased. For her father to be able to really be released and go someplace else, Jess, and tell this they could get into control. And just again, seeing the complexity, it's so easy to see in our own myopic world. Hear me in this remote town of Colorado and how no big deal, you know, it's not that it's not going to bother me. It w it would bother my mother-in-law. Does it expand so much more than in place that we're not even aware of? Right. So I just want to drop that to everybody, to, to, to hear, to listen, to, to take in that this affects in places that we have no concept of even, it's not part of our daily rhythm of life. So it's important. It's really, even if the desks are low, who would impacts, like you said, over and over Steven it's, it's always the most vulnerable. It's always the ones who actually don't have that freedom and flexibility, and that's why we're doing this. So that's a great illustration of that point for sure. Okay, next thing we're talking about, we talked about increase of cases. I want to help us navigate hospitalizations again, once again, I know we talked about this. It was three months ago. I had a friend dismissing this like surge of hospitalizations, trying to tell me I'm listening to the media. It's just media-related then you help to expose them say no, here's the complexity of it. Yes. You could probably see if there's 200 hospitals, maybe only 50 or overrun, but guess where they're at? Blah, blah, blah. So where are we at? At this state of the game in hospitalizations in our country. And it was a complex question because it depends right. And also help us navigate. Where could we look to, to help understand where this is going and which hospitals are suffering the most?

Stephen Kissler:

Yeah, this is, this continues to be tricky. So, there are a number of factors in play here. So, part of the reason we don't. Actively observe hospitals being over run on the news is, is because of the patient privacy guidelines that we have in the U S where you just don't have news cameras in hospitals. That's just like, not something that you do. So you don't get to see the hospitals where you have patients who are being treated in the hallways and these kinds of things. Which of course, I want to be clear as not, not all. And probably not even. I mean, it's not the majority of the hospitals right now. But there are some, many of them in the upper Midwest at the moment, just like there were in New York city earlier on and some in Florida when the outbreak was really raging there in the Southeast, So it happens and it continues to be the case that this epidemic strikes different places with different severity at different times. And that's just, just the way that it goes. And so it's not your hospital right now, but it very well could be. And that's where the question of exponential growth comes in here too, because, and I I've, I've heard a couple of interviews by, Policy makers, politicians, even hospital administrators who are sort of talking about how their hospital capacity is really robust, because they could deal with a, you know, even, even if one of them said, like, even if the number of cases coming in doubled, we'd be able to handle that. And it's like, well good, because they could double next week. you know, like that's, the, the speed with which these things can change is just mindblowing. and so. So it's tricky because there's part of the reason, there's so much alarm going on around the scientific community and in the media is because it's true. There are still a lot of hospitals that are not currently overrun, but they could be. If things continue going at this pace. And that's the concern is we're trying to avoid that now that said, hospitals have learned a lot, they've figured out how to rearrange their staff so that they can optimize who's working where and making sure that they have the staff to care for patients in the space. And they've really spent a lot of time this summer preparing. For this fall and winter surge, knowing that it was coming. And, and so that's helping a lot. So that hospitals that might have been overrun in the spring now have a lot more resilience this fall and this winter. And so, so in that sense, in some like hospitals have been very creative in increasing their capacity, increasing their ability to care for patients. And so all of that is really good too, and, and ends up serving the patients who do come through the door much better. So, so, so that's sort of, a bit on the good news side as well. Yeah. So it's still a very complex, problem here. but, it, it hospital capacity and meaning maintaining, Yeah, it's maintaining hospital resources, staff, making sure that the staff are not burning out, making sure that the staff are not getting sick themselves is one of the most important things we can do because that, that I think is our greatest vulnerability here. Because if, if, if hospitals start to be overrun, then that, that poses a much greater problems to health.

Matt Boettger:

And, you know, to equip me and quick to the listeners as well. If I were to look into this, like, Hey, where are we at? Instead of just trusting whatever media outlet. Cause you did this, like four, three or four months ago, you just looked up yourself. Is there a place that that's trusted that we can go? Or do you have to go from hospital to hospital? Is it a state by state, like website you go to, how do we look at where we're at?

Stephen Kissler:

Yeah, so many States departments of health. so for example, the one that I looked at earlier this year was the Florida department of health and they had a spreadsheet that was just listing there. Hospital beds and capacities and which hospitals were weren't at capacity. and so that's, you know, just published by them, to get a sense of the number of hospitalizations, the COVID tracking project, which is where a lot of, like New York times based as their data on them. I think a lot of Johns Hopkins. Yeah. Portal gets their data from the COVID tracking project. they do a really good job of tracking hospitalizations by state. Yeah. and I think even, by community, in some cases, and so you can go there to see what's happening as well. and so yeah, there are different, different sources of information. Yeah, for sure. where, where you can look at, or what's going, going on in any particular community at any given time, Yeah. So it can be, it can be a little, it does take some digging for sure, but it's out there to be found.

Matt Boettger:

Great. Well, maybe you can send me the link and we can put a shutter to COVID tracking project. I don't know if I've seen that one or not, but we'll put that in the show notes. So that'd be a great first step to check out as well. If you want to kind of keep up to date on hospitalizations. Okay. So now we went to hospital to increase of cases, hospitalizations, look at deaths. I found this article, fascinating breakthrough finding reveals why certain COVID-19 patients died, and this is way beyond my pay grade. So I'm throwing it right back to you with something about an auto antibody. I think it's in interferon or whatever it's called that's, I'm pronouncing it correctly. That somehow with COVID it's being suppressed in, in a lot of these patients who are the patients who die. So there were seen, and you guys had mentioned before that Mark has said it over and over and over that sometimes your, your auto immune system can work against you. It can switch. And I'm assuming this is what it's was talking about, but can you speak into this concept and what you've seen and how relevant this is and true. This might be.

Stephen Kissler:

Yeah. So again, I'm going to completely botch all of the biology and physiology here, so I'm not even gonna try. But, what I do know is that there there's, an article, I think this one came out in science a couple of weeks ago that was talking about this interferon cascade. I think cascade is the right thing. You can call it. I know that that's a word that people sometimes use yeah. With respect to it. So we're just going to throw it out there. but the idea is that, so. W w they were looking at and trying to follow this, this cohort of patients who had severe COVID infections and try to understand, how can we account for this? and the majority could be accounted for by the risk factors that we already know with obesity and heart disease. And, These kinds of things, already accounted for the bulk of the severe cases, but there was a subset of cases that could be accounted for by essentially just the makeup of the people's immune system, which was something inherent to them. And it's something that a person usually doesn't notice. You can, you can move along your life, just fine without, you know, noticing that you have this, Sort of that your immune system responds to infection in a different way. and it is only revealed when you're challenged with certain types of infections. And this happens to be one of those infections where it sort of reveals this thing, which, which for many people is genetically linked. so you can inherit it. and it's something that you just carry with you for life. And then, You don't even really know that it's there, but it can, it can contribute to severe infection. So, so the argument would then was that helps explain some of these cases that don't make a lot of sense based off of the other co-morbidities that we already know account for the bulk of severe infection. to my knowledge, I, I think that there, I dunno, I don't know what it would take to know if, if the, if you are a person who has this or not, I think that there are tests that can be done to do that, but they're not routine, medical tests. So, so it's not something that I imagine is going to be like rolled out on a large scale to try to like figure out who in the population has this or not. And I, I can't even give like a population prevalence of like what an individual person's risk is. but nevertheless, I think that what's important about this is that it does indicate one other. Avenue for severe infection to manifest itself. And if we know that, then we have a better chance at treating those patients as well. because we know one of the things that is underlying their severe disease and so that, that helps a lot with clinical care and then will hopefully help take off some of those severe cases, because they can be treated, for that earlier.

Matt Boettger:

Yeah, no, I'm glad you already preemptively asked. The question of that was making me a follow-up is how can we get tested to see whether we have this and, you know, not sure we'll look into it a little bit too. There is a way to do it. I'm just the first thing that came to mind to buy my own life, but a good that helps put things in perspective with that. let's get to a couple other things, CDC update. This is just quick on my end. this is going to sound almost like tongue in cheek and almost comical, but it's important to say they modified, the industry. To explicitly state that masks do protect wares from COVID 19. So this was an update to the CDC guidelines. The reason why I bring this up is I've heard over and over and over from a handful of friends thinking that the CDC is contradicting itself about advising to wear masks. But if you read the fine print, CDC says that masks are useless. Now I can't verify that whatsoever. And I, my, my just. My natural instinct is that that's just crap because it's just, yeah, I, yeah, just because I it's, it's hard to, to, to think of big places that are focusing on health to contradict themselves, it's usually a complex reality behind it. So it's a nice to see. this just be, be modified. And then the difference is by the way that it was known that it was really helpful to protect those that are, if we have it from other people getting it, but we're seeing, there's been a lot of evidence, a lot of researches for the CDC comes from its conclusion and I'll put the link in where it actually has further links about the studies done that actually there were itself is being protected quite well. So another reason to wear masks, it helps both people. Okay. So let's go to the next issue, which was big. It came up this morning between you. And Mark over text messaging. I got to see it from a distance Mark through an article our way saying, Hey, look at this, check this out. A study being done that may be COVID had been circulating. I don't know. I didn't read it so I'm gonna make it exaggerated. So then you can correct exaggeration a long time before we even knew. That it was actually out. And so right away, Stephen, you responded with another article saying, like, like the theme of this podcast, it's a little bit more complicated. So when you explain the actual, what Mark was trying to show, and then your response.

Stephen Kissler:

Yeah. So the article that, Mark was referring to, is one that came out just recently that was using serology to say, they, they used serological analyzed like the, basically the blood of people. Yeah. Italy, starting in September of last year. so prior to the detection of COVID-19, so a couple of months, so w with the start of the epidemic, as we know it being. Probably end of December, early January of this year. and they say that they found evidence of, Antibody response to the SARS, cov two spike protein, in people in Italy, all the way up to September and, and the numbers they reported were remarkable. They said that 11% of the people whose, antibodies that they tested, whose blood they tested back in September in Italy demonstrated this immune response to SARS cov two spike protein, 11%. Right? So that's like one in 10 people. Yeah. and so, from what I could tell their conclusion was that there's evidence that says coffee to you has been circulating for much longer than, than we think. and so that this may adjust our notion of, the history of the pandemic. Okay. So, we need to know a little bit about how immunity works. And so Corona viruses are interesting, many viruses do this, but we know this for sure, for Corona viruses as well. that serological studies can get duped by other strains of Corona viruses. So back in 2003, there was a study in a nursing home. So 2003, this is in the context of the original SARS outbreak. it had flared up, People were really concerned about it. There had been a couple of cases, outside of, Hong Kong and outside of mainland China. but at this point, basically there, there were no more real confirmed cases, but then this, this nursing home in British Columbia thought that they had a cluster of stars and they're like, yeah, what is going on? I was like, and this, this would have been huge, right? Like, yeah. If all of a sudden you had this like flare up of SARS, like that, that means that that epidemic is far from over. and they thought that it was a flare up of SARS because of the same kind of tests. They were doing antibody tests on people who had gotten severely infected with the coronavirus like illness. and they found evidence of an immune response to SARS proteins. and they ended up doing confirmatory testing using the genetic sequence of what the patients were infected with and found that it was in fact. The Corona virus OSI 43, which is one of the four that causes seasonal coronavirus transmission. So while the antibody suggested that it was SARS or could be SARS, further follow-up suggested that it was one of these common, Corona viruses. Now I can almost guarantee you that, especially with 11% positivity, that what they're probably seeing is cross-reactivity with one of the common Corona viruses and corroborating. This is there've been a number of, Genomic epidemiology studies that look at the genetic diversity of SARS cov two. And those are a very good way of, Pinning down the dates of the, of different infections. So you can imagine that if, if one virus spills over into humans and then start spreading, all of them are going to be related to that original virus. And you're going to be able to trace it back just like a family tree. and, and that's what you do because, you know, just like in a family tree where you notice something about the rough time of a generation of. Humans. We also know something about the rough time of a generation of viruses and how quickly they mutate. And so you can take that and, and triangulate back sort of aware of the first and when the first crossover happened. And all of the evidence that we have is very consistent that the crossover happened in and around UConn China in December. probably late November, early December and then was starting to spread and then was detected in late December. that's also corroborated by the clinical data where we know. We've now done antibody studies. We do a lot of surveillance. We know we have a rough sense of how many cases turn into severe cases. and if it was circulating that broadly, that early, we would have seen it in hospitals. Yeah. like there's, there's, there's

Matt Boettger:

no way

Stephen Kissler:

I have missed that. and so, and so I think that there's, this is one of those pieces. It's just another sort of incidence here where, there's. There's this really interesting finding that seems very clear cut at first, but then we need to figure out how to integrate it with all of the other information that we have. And then I think the story becomes more complex. So yeah, those are my responses to that.

Matt Boettger:

That's great. Yeah, that's a good one. Once you said 11%, you have to, my, my first thing that came, it's the power of anecdotal evidence. I'm like, gosh, the leverage sin. Why did we not see what we're seeing now? Like it was like, there was nothing, we're all having a great time and everything was so. Thanks for making those things come together and make sense. So caution very much. It looks like more than likely, some other, some other coronavirus, regular, strain. Okay. So let's now talk about the holidays. So it is, I saw this article college students from a home for the holidays, how to keep families safe. I think there was a more catchy title. It was like, should they even go, go to go home for the holidays? They're coming up in just over a week. I'm curious, just to poke your brain here a little bit to figure out what should students be doing, particularly being in an enormous university, many of which have seen, a lot of cases being thrown around. Should they be going home? How they should be going home? How should we be addressing the holidays in the next week or so?

Stephen Kissler:

All right. it's, this is really hard. And this is one of those things that I've been getting a lot of questions about both from friends and colleagues and from journalists. And, just to try to understand how to, how to calculate these trade-offs, and it's really hard. So I think. I will say for sure that, again, all of the same principles that we've been talking about still stand, like it's better. If you can maintain physical distance, it's better. If you can keep the sizes of gathering small, it's better. If you can avoid mixing households and people who don't normally see one another, But that said, I mean, there, there are plenty of good reasons why one needs to see one's family too. and so I think that the thing to emphasize here is that there are things that we can do to make it more safe than it might be otherwise. and I think it's important to do those things, which include before traveling. so now if you haven't started already, if you're thinking about traveling for Thanksgiving, Try to do a self quarantine, ideally for two weeks, we're now closer to, than that two week period. But for as many days as you can really try to restrict. Your, interactions with other people outside the home to help make sure that you're not picking up infection and bringing it to your loved ones. try to get tested before you go, try to get tested when you get there. and, you know, monitor your symptoms, maintain distance, wear masks while you're inside, have conversations, try to open up windows to maintain ventilation. just make sure that everybody knows what to expect. and so. It's tricky. But, but I do think that there are lots of ways to make this time of year, a lot safer than it could be otherwise, and to not totally, reduce, you know, to like halt everything that, all of the family gatherings and these kinds of things. Now, personally, I'm not going to be traveling back to Colorado for Thanksgiving. I think it's going to be much safer to stay put. you know, Thanksgiving is also the highest volume travel day of the year in the United States. So there's going to be a lot of people in airports, a lot of people mixing who wouldn't otherwise. and I think it's just better to stay put. but I, I'm not saying that as a, as a prescriptive sort of something that everybody needs to follow, but just to share sort of what, what I'm doing with this time. I'm planning to zoom in with a family, hopefully for a very long period of time. Maybe we'll cook something together and like have our normal meal over the computer. And, so it's gonna look very different this year. but, but I think that there's, there's so many things that we can do to help reduce risk. and I think that as long as we're doing those things, we can go a long way towards keeping the holidays from turning into another sort of venue for accelerating the upswing that we're already in.

Matt Boettger:

So I read in the article and that, that the flying itself was probably as being one of the safest things you could do because of the ventilation. They're there, the filters. And if everybody's wearing a mask the same time with the, with the filters, is that accurate? Now I get it. Now I get that. You don't just hop on a plane, you actually have to go through an airport and then be inside. So that's a whole other issue. That's like, it's not even speaking to that. Right. So I'm gonna pretend like that doesn't exist. Let's let's take reality out for a second and just look at the airplane. Like you, you operate into an airplane, right? I know this is not real, but just doing, is that an accurate thing that it seems to be if everyone's wearing masks and filter filtration, that, that it seems to be a low risk environment.

Stephen Kissler:

It seems to be, yeah. Both from, what we know about the spread of the virus, like you said, they have hospital grade air filters, they get an exchange of air every three minutes or so in most plane cabins, which is like really good. It's almost as good as being outside. everybody wearing masks is really good. So, yeah, from everything that I've seen as well, actually being on the airplane is a very low risk of, yeah. Very low risk of transmission. So yeah, if you can find a way to just sort of like operate on the airplane and just like pop in your seat, that would be great.

Matt Boettger:

I am going to get that technology in this summit. Great. We're gonna figure that out. You and I. Okay. So I have another follow-up because I just realized my wife talks about this and if I didn't throw it your way, but we're past due for Thanksgiving for this timeline, I'm gonna present this to you, but th but Christmas may be so. My wife has just what we're trying to prepare to see my mother-in-law. And so we could actually go indoors and just have a F and B feel free to be with her. So we're trying to the timeline of where do we need to be completely siloed for how long we mentioned two weeks, but then my wife she's, she's great at this. Her mind is just like very specific. She like no CDC says that says that, the incubation period could be up to up to 14 days. and then she, so her mind is like if the incubation periods up to 14 days, and then it's 10 days from when you have your symptoms to quarantine, she is saying it should be 24 days. We really want to be absolutely safe. Is that correct? Math of like, if you, if you're taking every precaution or the T or am I misunderstanding the two week window that we're typically telling people?

Stephen Kissler:

Yeah. So I needed to double check the CDC guidelines. So if, if it is. Truly the incubation period. then, then you may want to extend that a little bit further to make sure you get through the entire infectious period. Now, once a person starts showing symptoms, you're probably infectious for a little while longer, but your infectiousness drops off pretty quickly. a couple of days after you start showing symptoms and you can still feel symptoms for long after you've, you're really no longer, very infectious. So, I think that, 14 days is still a pretty safe span of time for an individual now, but I'll come at it from another perspective where now this is maybe arguing for a longer or longer span of quarantine, which is, so infectious, or incubation period. Yes. But one of the other concerns is that, so it's not each of you isolating individually, right? Presumably your family is still going to be interacting with each other. So in theory, what you could have is if one, and if you were infected, then they could spread it to another and they could spread it to another. And then that would extend the period of time in which one of you wasn't affected. Longer. and so accounting for the within household transmission can actually make it so that a household, if they want to be certain of not being infected or infectious with COVID needs to isolate for a longer period of time than an individual might. so that's sort of a subtle point there, but yeah. Yeah,

Matt Boettger:

man, it's, it's, that's like exponential growth for like self quarantine. Per member of family. I rely for you to get the real information. It says nearly 95%, efficacy, for, for the, the Medina virus. I mean, the that virus, but the vaccine, can you speak into that? Yes. That suck.

Stephen Kissler:

Yeah, that's right. Yeah. So again, really exciting. So this is, this is important on a couple of fronts. so. I'm trying to think about where to start. So first, the, the vaccine technology that Medina is using is pretty much the same technology behind the Pfizer vaccine. So what it is is, a RNA based vaccines. What that means is, is you're actually injected with a, a short segment of the SARS cov two genome that's encapsulated in these liquid proteins that basically allow it to enter into your body. And then your body's immune system. Attacks that, and then starts it mounts an immune response to the, the virus genome itself. So it's really able to identify, a and the proteins that are encoded by that genome, I guess, is really what it's doing. so that's. It's really cool. It's a technology that hasn't been used for any vaccines or any therapeutics before, but the technology itself has promise for many different types of vaccines now because, rather than having to figure out what. Protein and how to, how to encode a specific protein you can in theory, make these vaccines, just knowing the genome sequence, which is something that we knew within days of some of the first reported cases in China. So that, so that's really cool because in theory, this gives you a template for. generating vaccines against infections and also actually hoping for therapeutics against some other illnesses as well. this is much further down the road, but anytime your immune system is involved, which is basically with every illness that we have, these things could potentially help in some way, even though that's a little further down the road. Now, the other really cool thing about these, these vaccines is that it shows because both of these were the first two through the gate. It shows that these things can be done very quickly. So the next pandemic that we have, because there will be another one, you know, that, that suggests that this will be a primary candidate for generating a fast effective vaccine. So that gives us a lot of hope and helps us to sort of target and focus a lot of our efforts moving forward. So that's very good too. So that's about the technology in general. very cool. there's been a lot of, you know, many people were skeptical of this technology beforehand. It wasn't really sure if it would work or how effective it would be, but the fact that these are coming back with two high-level trials, coming back with 90 to 95, efficacy is, is huge. I mean, this is really a big proof of concept for this technology, which is very exciting. Now differences between Pfizer and the modern vaccine. So the key thing that I'm excited about about the maturing of vaccine is that it is more shelf stable. So whereas the Pfizer vaccine needs to be, stored at minus 80 degrees Celsius and can last in a refrigerator for about a week. The majority of vaccine can be stored at minus 20 Celsius and can be stored in a refridge for about a month. and so that means that it's, you don't require. As robust freezers to keep it cold. you can distribute it more widely. not many, not as many doses are gonna go bad if they're mishandled. and that's huge because that really expands where you can bring this vaccine to. so I think that that's really good as well. Now there's still a lot of data to come out on. Efficacy by age group and whether it's actually blocking transmission as well. yeah, that's something we still don't know. but I anticipate that it probably will at some level, I don't know if it'll be quite that same 90% efficacy. so still lots of data to come out, but these are two very good shots on goal.

Matt Boettger:

That's great. And again, I asked you this last week, I forgot when might we know now with Pfizer and, Madonna having these great results, those nuance questions. Is that going to be really soon within next month or so, or after we started ministry?

Stephen Kissler:

We should have, we should have some answers to some of those questions within the next month or so. they still haven't completed their phase three trials yet. These are some interim results that they've published. And I think as soon as they finished the phase three trials, we should know a lot more about the age breakdown and, some of these other important questions, but some of them, we will have to wait until it's in a bigger portion of the population and then do some followup analysis to really know for sure. But

Matt Boettger:

yeah. And of course I have no idea that between the negative 20 and negative 85 degrees Celsius, I'm a Fahrenheit dude. but I clearly it's really cold. so I don't even know, like, is there a difference in the sense of like, When you get to that cold does a typical freezer. Like I have, I mean, my concern is, is that like a novel difference because either one needs a special freezer or does the negative 20 they're just more widely available those times of freezers around the country, available to store them.

Stephen Kissler:

Yeah. Minus 20 will be a lot more available. okay. Cheaper to purchase. If a place doesn't have one, all of which matters a lot.

Matt Boettger:

Yeah. Yeah. And I was wondering am, I guess I was concerned as having that even for a first world country like us, we can probably do that relatively easy. I'm guessing this kind of accident a third world country is going to be really, really hard to, to exactly, to that's going to be a whole, I don't even know how you would do that really. so that's, that's to be, I guess, determined. Okay, that sums it up. Thanks so much, Stephen. It's great to hear the good news about this vaccine. Can't wait to hear more information. If you want to reach out to Steven a and get his curated Twitter feeds that he has. And we learned about last week that are phenomenal. S T E P H E N K S S L E R. Reached out to us, Matt living the real.com. Let us know how you're doing. If you, if you have any questions, send them our way. If you're part of our community and listen to us regularly in your, around the world, let us know how it is going in your neck of the woods, to just to hear how you're handling it and until then have a wonderful week. And again, it's next week, Thanksgiving week, Steven, right? Okay, so we need to talk Steven, Mark and I, whether we'll be on next week on Thanksgiving week. Cause, I know we're, I'm taking some time off as well, so we may not have an episode next Monday and let you know if you don't see anything up, that's the reason why, or we might sneak one in. We'll see, just want to let you know ahead of time while Mark Steven Knight chat about the details, have a wonderful week and we'll see you very soon. Take care. Bye-bye.